Specialist-Claims (Corporate Solutions)

At AIA we've started an exciting movement to create a healthier, more sustainable future for everyone.

Sound like you Then read on.

About the Role

To process complex inpatient and outpatient claims for Group Policyholders and apply strong technical judgment, digital tools, and data driven insights to ensure fair claim outcomes, effective risk and fraud identification, and continuous improvement of claims processes.

• Independently assess complex claims by applying strong technical judgment, policy interpretation, and medical understanding to ensure fair and accurate claim outcomes.

• Leverage digital tools, rules engines, and available automation outputs to enhance assessment efficiency, while exercising human judgment for cases requiring interpretation, exceptions, or escalation.

• Analyze medical reports, invoices, and supporting documentation to validate claim eligibility, identify inconsistencies, and determine appropriate claim decisions in line with policy terms and exclusions.

• Ensure claims are processed within defined turnaround time (TAT), productivity, and quality benchmarks, balancing speed with accuracy and service excellence.

• Identify, investigate, and escalate potential fraud, abuse, or leakage risks, working closely with the Fraud Investigation Unit and relevant stakeholders to support effective risk mitigation.

• Manage claims requiring additional information by preparing clear, professional, and compliant correspondence to claimants, healthcare providers, and third parties, ensuring timely followups and resolution.

• Resolve payment discrepancies and suspense items through coordination with Finance, customers, and internal teams to ensure accurate and timely settlement.

• Provide technical guidance, coaching, and knowledge sharing to junior assessors, supporting consistent decisionmaking, quality improvement, and team capability uplift.

• Identify opportunities for process improvement, simplification, and automation, contributing ideas and feedback to enhance claims accuracy, efficiency, and customer experience.

• Collaborate effectively with internal and external stakeholders (e.g. business partners, hospitals, service providers) to resolve escalations and support positive customer outcomes.

• Perform additional duties as required to support operational resilience, service continuity, and evolving business needs.

Requirements

• Minimum 3 years of relevant experience in handling minor medical claims

• Strong technical knowledge of claims assessment, including policy interpretation, exclusions, medical terminology, and dispute resolution, with consistent application of judgment and controls.

• Analytical mindset with the ability to interpret data, trends, and exception indicators, including fraud flags, anomaly alerts, and quality findings to support sound, riskbased decisionmaking.

• Strong problemsolving and criticalthinking skills, particularly in handling exceptions, escalations and nonstraightthrough processing cases.

• High level of attention to detail and followthrough, ensuring completeness, accuracy, and timely closure of claims and related correspondence.

• Effective communication skills, both written and verbal, with the ability to explain claim decisions clearly and professionally to internal and external stakeholders through digital channels.

• Willingness and ability to adapt to change, including adoption of new systems, automation, analytics tools, and evolving claims practices.

• Demonstrate commitment to continuous learning, skill development and participation in process improvement initiatives.